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Embedding the outcomes approach

Balancing rights and responsibilities: considering risk

Balancing rights and responsibilities can be difficult, as professionals often see risk as something to avoid and control, instead of being part of a shared decision-making process.

In reality, taking some risks is an important part of everyday life that supports people to do what matters to them.

We commissioned some work to co-produce practice principles for balancing risks, rights and responsibilities in adult services. The principles set out how social care practitioners can take a positive and shared approach to making decisions about risk.

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Practice principles Balancing risks, rights and responsibilities for adults: a positive approach to risk

We’d like to know how we can help you use these principles in your practice, take a moment to answer our survey.

The work builds on a study we produced to help understand how professionals who support people can move towards shared decision making, which found that decision-making should be:

  • balanced - recognising the potential for benefit as well as the risk of harm, and considering the possible emotional, psychological, social and physical impact of each option
  • defensible - well-founded, justifiable and recorded proportionately, and not defensive or driven by the need to protect ourselves and our agencies
  • collaborative - with people who use services, their families and other professionals, using all available resources to achieve the outcomes that matter most to people.

You can read the full report below:

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Positive risk and shared decision-making - by Imogen Blood and Shani Wardle

There are common principles across similar models

Children’s services currently use several models which might be described as ‘outcome focused’, ‘strengths based’ or ‘relational’. All of these models are based on similar principles:

  • a collaborative relationship between the practitioner and individual/family, developed through active and reflective listening, and based on empathy and a recognition of differences of power
  • a belief that change is possible and that ambivalence is natural
  • affirming strengths and building on exceptions, balanced with assessing risks
  • honest and open conversations with families and others about risks
  • working with individuals and families to identify solutions and set goals
  • identifying and mobilising wider networks and resources
  • taking a whole systems approach to families, communities and services.

What supports practitioners to work in this way?

Effective and regular supervision is key and should:

  • ‘hold’ tension and uncertainty by providing a secure base for practitioners to think about and consider their interaction with families and other professionals, and to process their own emotional responses
  • constructively scrutinise each other’s judgements
  • promote a learning culture where creative practice with families is encouraged and risk and proposed innovation is openly debated
  • discuss the values which inform practice
  • seek out the exceptions, strengths, desired outcomes and possible solutions with families
  • promote shared responsibility for risk.

Other factors that were supportive of practitioners working in this way are:

  • developing skills and training, backed up by opportunities to shadow and co-work
  • maximising opportunities for earlier intervention
  • involving families in safety planning to build their capacity to prevent and respond effectively to crisis in the future
  • recognising the impact that poverty can have on families, with practitioners being sensitive to power and structural inequalities.

Watch this video to see how social worker Dawn works with a parent to develop a safety plan:

What gets in the way of practitioners working in this way?

  • a performance system which focuses on processes, tasks and outputs, rather than on the quality of engagement and tangible outcomes for children and young people
  • pressure from inflexible timescales
  • increasing demand within a context of reduced resources
  • a blame culture in services, the wider system and the media which can increase defensive practice
  • assumption that a quantifiable threshold is possible in a complex situation
  • taking an over-simplistic view of risk factors
  • court processes increasing defensive and adversarial practice.

Why is hearing the child’s voice in child protection processes important?

  • the legislative framework is clear that children should be involved in decision-making when they are subject to statutory processes
  • where children are unseen, and their voices are unheard, there is more likelihood of unsafe practices
  • effective involvement of children and young people allows practitioners to develop a better understanding of their needs are as early as possible
  • when they are involved in their plans children and young people are more likely to be empowered, they can feel they are a part of the positive changes happening in their families effectively involved children and young people report more positive experiences in child protection processes.

What children and young people value in child protection services

  • the opportunity to build a trusting relationship with their worker
  • receiving clear, accessible and timely information about processes, meetings and plans
  • being able to decide whether to attend meetings and supported to contribute if they do; or being involved in decision-making in other age-appropriate ways

Watch social worker Ian use the ‘drama triangle’ to describe how children can view formal interventions from services:

Why collaborate with parents and carers in child protection services?

  • better engagement with families improves the ability of workers to get a fuller picture of the well-being of children
  • when parents’ strengths are recognised by professionals, this can improve their morale and their motivation to change
  • increased likelihood of improved outcomes when parents are actively involved in developing child protection plans
  • a lack of effective engagement with and support for parents whose children are removed may increase the chances of them being unable to cope as a parent in the future, and having further children removed – particularly for younger parents
  • families’ experiences and views must be seen as a resource to help improves systems and processes; we can learn from existing practice about what works well to engage parents who may have been initially hostile.

What parents and carers value in child protection services

There is a relatively small body of research evidence regarding the views and experiences of parents and carers within child protection processes. When asked however, there is a consistent message of wanting to be more involved when their children are subject to statutory child protection services. Specifically, parents and carers say they value or would like:

  • clear, jargon-free information about the processes and time and support to digest the information at their own pace
  • the opportunity to build a relationship with a (ideally one) social worker, who gets to know the family, spends time with their children and acts ‘like a human’
  • hands-on support, not just monitoring
  • a balanced approach with workers and their reports acknowledging parents’ strengths and positive intentions, but also being frank and specific about concerns and risks
  • conferences which don’t involve too many people or too many surprises, and which are as informal and inclusive as possible
  • workers who ask parents for their ideas about solutions within their own families, and also seek their feedback about how the wider system and processes might be improved
  • plans which set out clearly what is expected of them, focusing on outcomes and not just outputs, and are followed without ‘moving the goalposts’
  • workers who are non-judgemental, reliable and trustworthy
  • workers who really listen and recognise how stressful and traumatic these processes can be for families.

Listen to a parent talk about how being worked with in an outcome focused, strength-based way supported her to make changes for herself and her children:

Listen to Keri talk about how she encouraged culture change in children’s services by collaborating with families and front-line staff:

What leadership is needed to embed this way of working?

These ways of working need to be part of whole systems change if they are to be embedded. Leaders have a key role to play and should:

  • model strengths-based, collaborative and co-productive approaches in their own leadership style
  • support practitioners to identify what they’re doing which is working to improve outcomes for children, and help to think about how they can build on this
  • celebrate and promote good practice – to reinvigorate social work with children and families
  • templates and processes that have been co-produced with families and front-line workers
  • promote shared values and consistent ways of working across agencies
  • share responsibility across the system rather than protection of individual budgets and passing on risk.

Listen to Maria explain how changing paperwork and processes to become outcome focused made a positive difference to families:

Questions for further self-reflection and discussion

Practice:

  • what is the quality of your relationships with families?
  • what are the benefits and challenges of building a relationship with families?
  • what are the risks to you and our organisation of working more collaboratively with families?
  • what are you already doing that works to manage risks collaboratively with families?
  • do families understand our concerns, what they need to do about it and what the consequences might be? How do you know?
  • what role do you play in supporting collaborative work with families?
  • what might a successful outcome look like for families? Can you give an example and what the components were that brought this about?
  • what would the families you work with say has been the most useful to them to help them manage risks better?
  • how do you know the children you work with are safer?

Strategy:

  • how do you create a culture where you’re able to manage risks collaboratively with families?
  • how does your organisation support creativity, curiosity and hold ambivalence and uncertainty in practice?
  • what do you notice about your organisation when things go wrong?
  • which of the processes are helping families most; which could be counter-productive?
  • do you articulate and measure ‘risks’ and ‘outcomes’ in terms of concrete differences for children and families, or in terms of ‘your’ processes?
  • how can different parts of the system, and partner agencies, best support each other to manage risks collaboratively?
  • what is the role of elected members in this?
  • what would be the trigger/motivation to change the system in your organisation?

Outcomes focused supervision and reflective practice

Taking an outcomes approach requires a culture of co-production, practitioners need to build their skills, confidence and capabilities in strengths-based working. To support this cultural shift, we a whole system change to ensure all processes and policies support this was of working

This means building personal outcomes into:

  • support for staff
  • workforce planning
  • performance management
  • continuing professional development.

Supervision is a two-way process, which supports, motivates and enables professionals to develop good practice. Supervision provides regular contact between a supervisor and a worker, where space is given for reflection and learning.

Good two-way discussion is at the heart of the supervision experience, modelling the outcomes approach which is strengths based and outcomes focused. The supervisor’s practice framework will influence the nature of the discussion which, in turn, shapes the process of review, reflection, evaluation and outcome setting.

In the same way that we should be building relationships with families where power ‘with’ rather than power ‘over’ is established, an environment where both supervisor and supervisee can contribute their expertise to the relationship should be developed.

This way of working supports supervisees to find solutions within themselves based on their existing strengths and prior positive experiences.

Outcomes focused supervision can be structured using the following discussion framework:

  • what are we working towards (outcome)?
  • what is working well (strengths)?
  • what are we worried about (priority risks)?
  • what needs to happen (what options are we exploring)?
  • where are we now (what has been the progress so far)?
  • where do we want to be (what are the next steps)?

Watch these videos to see how using outcomes focused supervision supports the worker to reflect on her work.

You’ll see in the first video about the ‘traditional’ supervision session that it’s not outcome focused. It gives less space for reflection.

Now watch the video below about using an outcomes approach in a supervision session. Compare the two videos and see how the second focuses on personal outcomes, priority risks and good enough outcomes.

The following resource can be used to support supervision:

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A guide to supervising and appraising well

Outcome focused group reflection

Group reflection should also be used to support an outcomes approach, this is different to supervision. Group reflection brings teams together to discuss case work, share practice and support decision making.

Group reflection can be done as part of a regular team meeting or can be structured to support regular team development and provides an excellent learning opportunity to develop confidence and capabilities in outcomes focused practice.

During reflection a member of the team will talk about one of their cases for 10-15 minutes and the rest of the team will listen without interruption. When talking through the details they will share details following details about the person and/or the family they’re been working with:

  • strengths
  • outcomes
  • priority risks
  • what needs to happen?
  • where are we?
  • where do we want to be?

The team can then ask clarification questions and constructively challenge to ensure that an individual’s network, community services and lastly commissioned options have been fully explored. The discussion can support decision making and should be recorded in a way that shows the reflective and decision-making stages. When group reflection is strengths based it can increase motivation, creativity and confidence of practitioners and their managers.

This resource shows how to facilitate an outcome focused reflective group session:

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Format for outcome focused reflective groups